森本 恭子^{1, 2}, 河岡 友和³, 相方 浩³, 盛生 玲央奈³, 盛生 慶³, 中原 隆志³, 濱田 麻紀^{1, 2}, 有廣 光司⁴, 横崎 典哉¹, 茶山 一彰³

Kyoko MORIMOTO^{1, 2}, Tomokazu KAWAOKA³, Hiroshi AIKATA³, Reona MORIO³, Kei MORIO³, Takashi NAKAHARA³, Maki HAMADA^{1, 2}, Kouji ARIHIRO⁴, Michiya YOKOZAKI¹, Kazuaki CHAYAMA³

¹広島大学病院検査部, ²広島大学病院診療支援部生体検査部門, ³広島大学病院消化器・代謝内科, ⁴広島大学病院病理診断科

¹Division of Laboratory Medicine, Hiroshima University Hospital, ²Division of Physiological Function, Department of Clinical Practice and Support, Hiroshima University Hospital, ³Department of Gastroenterology and Metabolism, Hiroshima University Hospital, ⁴Department of Anatomical Pathology, Hiroshima University Hospital

キーワード : hepatic angiosarcoma, contrast-enhanced ultrasonography, hepatic hemangioma, Sonazoid<SUP>&reg;</SUP>, SonoVue<SUP>&reg;</SUP>

症例は80代，男性．便通異常で経過観察中，肝機能異常を認め，腹部CTにて肝右葉に40 mm大の腫瘤性病変を認め入院精査となった．腹部超音波検査（US）では肝S7に40 mm大の類円形の腫瘤を認めた．腫瘤の境界はやや不明瞭，辺縁は不整，内部不均一な高エコーを呈した．Sonazoid^®造影超音波検査（CEUS）では動脈優位相で腫瘤辺縁に不整にまばらな濃染，門脈優位相で辺縁から中心部に徐々に不均一な染まりを認め，後血管相10分では淡い欠損像を呈したが内部に不均一な染影像を認めた．濃染パターンは肝血管腫と類似していた．入院3ヵ月前に他臓器の評価を目的とした単純CT画像と比較すると急速な腫瘤の増大と左胃動脈領域のリンパ節転移が認められたため，肝血管肉腫が疑われた．超音波ガイド下肝腫瘍生検が施行され病理組織所見では肝血管肉腫と診断された．今回，CEUSにて評価しえた肝血管肉腫の1例を経験したので報告する．

We report a case of hepatic angiosarcoma. An 80-year-old man with impaired liver function was admitted to our hospital for detailed examination. Contrast-enhanced computed tomography (CECT) revealed a tumor lesion, which was 40 mm in diameter at segment 7 of the liver. Abdominal ultrasonography (US) showed a hyperechoic mass with an inhomogeneous and slightly unclear margin. Contrast-enhanced ultrasonography (CEUS) showed sparse irregular peripheral nodular enhancement on the arterial phase, and partial centripetal filling on the portal phase. The mass was slightly hypoenhanced 10 minutes later on the post vascular phase, but the internal nodular heterogeneous enhancement persisted. The enhancement pattern was similar to that of a typical hepatic hemangioma, but we suspected a hepatic angiosarcoma. Compared to plain CT performed for evaluation of another organ 3 months previously, CECT showed a rapidly growing mass in the same region of the liver with lymph node metastasis of the left gastric artery. We performed ultrasound-guided biopsy, and the lesion was pathologically diagnosed as hepatic angiosarcoma.